Non-medical prescribing in Australasia and the UK: the case of podiatry

Background: the last decade has witnessed a rapid transformation in the role boundaries of the allied healthprofessions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategyof health care ‘modernisation’ has encompassed calls for the redrawing of professional boundaries and identities,linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domainof medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped tomeet the challenges posed by changing demographic, social and political contexts. The prescribing of medicinesby non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects thesechanges.Methods: using a range of key primary documentary sources derived from published material in the publicdomain and unpublished material in private possession, this paper traces the development of contemporary UKand Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sourcesinclude material from legislative, health policy, regulatory and professional bodies (including both State and Federalsources in Australia).Results: tracing a chronological, comparative, socio-historical account of the emergence and development of‘prescribing’ in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reformson the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled withdemands for workforce flexibility and role transfer within a climate of demographic, economic and social changehas enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply,administration and prescription of medicines.Conclusion: as a challenge to medical dominance, these changes, although driven by wider healthcare policy,have met with resistance. As anticipated in the theory of medical dominance, inter-professional jurisdictionaldisputes centred on the right to access, administer, supply and prescribe medicines act as obstacles to workforcechange. Nevertheless, the broader policy agenda continues to ensure workforce redesign in which podiatry hasassumed wider roles and responsibilities in prescribing